CLINICAL IMAGE
Giant diverticulum- A rare complication of a common surgical condition Vanessa Cubas1, Stephen T. Ward2 & Jan Dmitrewski1 1
Queen Elizabeth Hospital, Mindelsohn Way, Birmingham, B15 2TH, UK National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit (BRU), University of Birmingham, Vincent Drive, Birmingham, B15 2TT, UK
2
Correspondence Vanessa Cubas, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham, B15 2TH. Tel: 07729456671; Email: [email protected] Funding Information This article has been funded by MRC (Medical Research Council).
Key Clinical Message A gentleman presented with abdominal distension and pain. CT confirmed a 20 cm sigmoid diverticulum. A giant diverticulum, typified by diverticula greater than 4 cm, often requires colonic resection. Fewer than 200 cases have been reported, most measuring 7–15 cm. I present a rare complication of a common surgical condition with images. Keywords
Received: 11 August 2015; Revised: 5 November 2015; Accepted: 11 February 2016
Diverticular disease, general surgery, giant diverticulum, sigmoid diverticulum.
Clinical Case Reports 2016; 4(5): 531–532 doi: 10.1002/ccr3.534
Introduction What is this condition? Giant colonic diverticulum A 65-year-old gentleman presented with abdominal distension and pain. CT confirmed a 20 cm sigmoid diver-
Figure 1. CT showing a 20.3 cm sigmoid mass in keeping with giant diverticulum.
ticulum (Fig. 1). Although he was clinically well a sigmoidectomy was performed due to the risk of perforation (Fig. 2). The patient was discharged 3 days later. Giant diverticulum, typified by diverticula greater than 4 cm, is a rare manifestation of diverticular disease of the colon. It affects the sigmoid in 90% of cases [1]. Since it
Figure 2. Specimen following sigmoidectomy.
ª 2016 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
531
V. Cubas et al.
Giant diverticulum
was first described by Hughes and Green in 1953, there have been fewer than 200 cases reported with most measuring between 7 and 15 cm. Although etiology is not clearly understood, it is believed that a one-way valve is created at the communication between the colon and the sac leading to air entrapment and a gradual distension of the sac [2]. Treatment usually entails surgery: colonic resection with a primary anastomosis.
References 1. Grover, H., S. Nair, and H. Hertan. 1998. Giant true diverticulum of sigmoid colon. Am. J. Gastroenterol. 93:2267–2268. 2. Naber, A., A. M. Sliutz, and H. Freitas. 1995. Giant diverticulum of the sigmoid colon. Int. J. Colorectal Dis. 10:169–172.
Conflict of Interest None declared.
532
ª 2016 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
Giant diverticulum- A rare complication of a common surgical condition Vanessa Cubas1, Stephen T. Ward2 & Jan Dmitrewski1 1
Queen Elizabeth Hospital, Mindelsohn Way, Birmingham, B15 2TH, UK National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit (BRU), University of Birmingham, Vincent Drive, Birmingham, B15 2TT, UK
2
Correspondence Vanessa Cubas, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham, B15 2TH. Tel: 07729456671; Email: [email protected] Funding Information This article has been funded by MRC (Medical Research Council).
Key Clinical Message A gentleman presented with abdominal distension and pain. CT confirmed a 20 cm sigmoid diverticulum. A giant diverticulum, typified by diverticula greater than 4 cm, often requires colonic resection. Fewer than 200 cases have been reported, most measuring 7–15 cm. I present a rare complication of a common surgical condition with images. Keywords
Received: 11 August 2015; Revised: 5 November 2015; Accepted: 11 February 2016
Diverticular disease, general surgery, giant diverticulum, sigmoid diverticulum.
Clinical Case Reports 2016; 4(5): 531–532 doi: 10.1002/ccr3.534
Introduction What is this condition? Giant colonic diverticulum A 65-year-old gentleman presented with abdominal distension and pain. CT confirmed a 20 cm sigmoid diver-
Figure 1. CT showing a 20.3 cm sigmoid mass in keeping with giant diverticulum.
ticulum (Fig. 1). Although he was clinically well a sigmoidectomy was performed due to the risk of perforation (Fig. 2). The patient was discharged 3 days later. Giant diverticulum, typified by diverticula greater than 4 cm, is a rare manifestation of diverticular disease of the colon. It affects the sigmoid in 90% of cases [1]. Since it
Figure 2. Specimen following sigmoidectomy.
ª 2016 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
531
V. Cubas et al.
Giant diverticulum
was first described by Hughes and Green in 1953, there have been fewer than 200 cases reported with most measuring between 7 and 15 cm. Although etiology is not clearly understood, it is believed that a one-way valve is created at the communication between the colon and the sac leading to air entrapment and a gradual distension of the sac [2]. Treatment usually entails surgery: colonic resection with a primary anastomosis.
References 1. Grover, H., S. Nair, and H. Hertan. 1998. Giant true diverticulum of sigmoid colon. Am. J. Gastroenterol. 93:2267–2268. 2. Naber, A., A. M. Sliutz, and H. Freitas. 1995. Giant diverticulum of the sigmoid colon. Int. J. Colorectal Dis. 10:169–172.
Conflict of Interest None declared.
532
ª 2016 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
